Resumen

Background: No scoring system has been published to date to assess the risk of superinfections (SI) for high-risk children with febrile neutropenia (HRFN). Methods: SI diagnoses during or 1 week after initiating antibiotic therapy in HRFN children were evaluated. Eight hundred and forty-nine episodes of febrile neutropenia (FN) were included in a prospective study to evaluate a scoring system designed to identify SI. Results: In the derivation set (566 episodes), 17% had SI. A multivariate analysis identified the following significant SI-related risk factors: acute lymphoblastic leukemia-acute myeloid leukemia (ALL-AML, OR, 1.87; 95% CI, 1.13-3.10), central venous catheter (OR, 2.11; 95% CI, 1.23-3.62), and febrile episode occurring within 10 days after chemotherapy (OR, 1.86; 95% CI, 1.09-3.15). A SI scoring system could be built: 1 point for ALL-AML, 1 point for the presence of a central venous catheter, and 1 point for the febrile episode occurring within 10 days after chemotherapy. If patients collected 3 points, then their risk of SI was 25.8%. With 2 points the risk was 16.7%, and with one minimum score of 1 point, their risk was 10.9%. The sensitivity to predict SS was 100% and its negative predictive value (NPV) was 100%. In the validation set (283 episodes), 49 (17%) children had SI. For children with scores > 0, the scoring system yielded a sensitivity of 100%, and a NPV of 100% for predicting SI. Conclusions: The use of a SI score for HRFN patients was statistically validated by these results. A better initial predictive approach may allow improved therapeutic decisions for these children.

Palabras clave: Superinfections secondary infections febrile neutropenia children cancer.

2011-04-15   |   931 visitas   |   Evalua este artículo 0 valoraciones

Vol. 68 Núm.1. Enero-Febrero 2011 Pags. 40-47 Bol Med Hosp Infant Mex 2011; 68(1)